FORM 1023-EZ for THE MINDFUL AMERICAN

Field Data
EIN 47-1802288
Case Number EO-2014293-000179
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE MINDFUL AMERICAN
Organization’s Mailing Address 28202 CABOT RD STE 300
City LAGUNA NIGUEL
State CA
ZIP 92677
Accounting period End 12
Primary contact name ARICA DEMARCUS-DADJOU
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ARICA DEMARCUS-DADJOU
PRESIDENT, DIRECTOR
28202 CABOT RD STE 300
LAGUNA NIGUEL CA 92677

Officer/Director/Trustee Two

TINA LEHMAN
SECRETARY, DIRECTOR
14094 BLUE RIVER TRAIL
BROOMFIELD CO 80023

Officer/Director/Trustee Three

KIMBERLY CURTIS
TREASURER, DIRECTOR
641 W LEMON AVE
MONROVIA CA 91016

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/3/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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